Needle Stick Injuries: The Sleeping Threat to Healthcare Worker Safety.

Today

• Scope of the problem.• Implementation of Risk Management

Program– identification– analysis– prevention and control

• Lessons to be learnt.

Question?

Where is the most dangerous place to work?

Question?

What is the single greatest occupational hazard to medical personnel?

Scope of the ProblemInternationally

• Before 1980, needlestick injury prevention was not as much of an issue (pre-AIDS).

• In the late 1980’s the Centers for Disease Control and Prevention (CDC) introduced “Universal Precautions” to protect healthcare workers from bloodborne pathogens.

• 1991, The Occupational Safety and Health Administration (OSHA) published its rule “Occupational Exposure to Bloodborne Pathogens” to further protect healthcare workers.

Scope of the ProblemInternationally

• While as many as 20 blood borne pathogens can be transmitted through accidental NSI’s, the potentially life threatening are HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV).

• A health care worker’s chance of contracting – HIV 1:250– HBV 1:20– HCV 3.5:100

Scope of the ProblemLocally

• 2006- Only 6 cases reported.• There was a lack of information about the various

factors that cause accidents with needles. • No Surveillance program to provide in-depth

information.• No analysis of the data collected which could provide

useful information for designing effective prevention strategies.

Implementation of Risk Management Program.

• “One of a number of organisational systems or processes aimed at improving the quality of healthcare, but one which is primarily concerned with creating and maintaining safe systems of care.”

Incidence of needle sticks injury

All measures according to IPP implemented

First aid for the employee

Reporting to supervisor

Reporting to QMD, Writing OVA

Employee examination in ER, EHC

History taken, complete physical examination

Employee serological tests for HBs AG, Anti HBs, Anti HCV, anti HV

Patient MRP notification, patient examination

Patient serological tests for HBs AG, Anti HBs, Anti HCV, anti HV

OVA form

Employee consent

Patient consent

Negative results of investigation

Continuous monitoring according to IPP

Post exposure prophylaxis

Employee counseling

Management of exposure

Employee Needle sticks Control Chart

0

0.5

1

1.5

2

2.5

3

3.5

J an-06

Feb-06

Mar-06

Apr-06

May-06

J un-06

J ul-06

Aug-06

Sep-06

Oct-06

Nov-06

Dec-06

J an-07

Feb-07

Mar-07

Apr-07

May-07

J un-07

J ul-07

Aug-07

Sep-07

Oct-07

Nov-07

Dec-07

J an-08

Feb-08

Mar-08

Apr-08

May-08

J un-08

J ul-08

Aug-08

Sep-08

Oct-08

Nov-08

Dec-08

Employee Needle sticks

UCL

LCL

Mean

Special cause

Trend

6400

6600

6800

7000

7200

7400

7600

Year 2006 Year 2007 Year 2008

total Number of admission

0.00%0.02%

0.04%0.06%0.08%0.10%0.12%0.14%

0.16%0.18%0.20%

Year 2006 Year 2007 Year 2008

% of Needle stick injuries for total admission

Series1

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

L& Ddepartment

OperatingRoom

EmergencyDepartment

DentalDepartment

CSSD Inpatientdepartment

Out patientDepartment

PHC Lab Intensivecare unit

Area of Occurrence

Percent

0

2

4

6

8

10

12

14

16

18

StaffPhysician,

Consultants

Staff Nurse Dentist HouseKeeper

Labtechnician

CSSD staff

Empolyee Injured

Percent

80%

6%14%

Positive Result for both sides ( Patient and Employee)

Negative Results ( Patient and Employee)

Main source not investigated ( Patient)

Percent

8.50%

11.50%

11.50%

14%

3%8.50%

17.50%

6%

8.50%

6%6%

Doing / removal of suture during surgical procedures Medication administration Perform incision during operation

Extracting blood sample Exposure of lacerated skin to blood Handling and receiving sharp instrument ( scalps) in OR

Insertion of canula/ CVP line/ Epidural Recapping of the needle after use Cleansing procedures

Disposal of the used needle Removing sharp instruments for the set

Percent

17.50%

48%

6%

28.50%

Avoidable accidental practice Non Avoidable accidental practice

Improper Equipment (sharp containers, syringe type…) Malpractice

Risk Prevention and Control

• Perform a walk-through of your facility to assess the locations, emptying schedules, and security of containers.

• Does the sharps container require one or two hands to operate?

• Are the sharps containers located in convenient locations and at the proper height?

Risk Prevention and Control

• The optimal installation heights for fixed, wall-mounted containers are:– Standing workstation: 52-56 inches above the standing

surface of the use– Seated workstation: 38-42 inches above the floor on

which the chair rests

Risk Prevention and Control

• Procedures: Receive training and PRACTICE before you perform a procedure on a patient, whether or not a safety product is being used.

• Products: Familiarize yourself with the products before you use them. If a safety product is used, always use it correctly and consistently to avoid a NSI.

Risk Prevention and Control

• ALWAYS be considerate of others. Dispose of all used needles and sharps in the appropriate containers.

• Expect the unexpected. Have an adequate number of supplies readily available for the procedure and ask for help from a co-worker if necessary.

• Be extra careful during emergent situations. Always keep exposed needles pointed down and away from yourself and others. Alert co-workers when you have a needle or sharp in your hand.

Risk Prevention and Control

• Always wear properly fitting personal protective equipment - gloves, eye protection, etc.

• Never reach into trash cans, basins or other containers with your hands. You never know when there might be a hidden needle.

• Never place trash against your body to compress or secure it!

Risk Prevention and Control-Education!

• Education of healthcare workers is critical in promoting a safe environment.

• It should be provided during orientation, annually, and on a “as-needed” basis to all healthcare workers.

• Those who actually use needles and other sharp objects should be given additional training, including “hands-on” sessions in using products.

Lessons to be Learnt

• Blood collection, device use and disposal are part of a complex multistep process.

• Safety devices and safety procedures do not work alone.

• Interdisciplinary approach.• Promotion of organisational safety culture.• Leadership and managerial support.

Employee Safety

Thank You!